As Congress mulls potentially massive cuts to federal Medicaid funding, health centers that serve Native American communities, such as the Oneida Community Health Center near Green Bay, Wisconsin, are bracing for catastrophe.

That’s because more than 40% of the about 15,000 patients the center serves are enrolled in Medicaid. Cuts to the program would be detrimental to those patients and the facility, said Debra Danforth, the director of the Oneida Comprehensive Health Division and a citizen of the Oneida Nation.

“It would be a tremendous hit,” she said.

The facility provides a range of services to most of the Oneida Nation’s 17,000 people, including ambulatory care, internal medicine, family practice, and obstetrics. The tribe is one of two in Wisconsin that have an “open-door policy,” Danforth said, which means that the facility is open to members of any federally recognized tribe.

But Danforth and many other tribal health officials say Medicaid cuts would cause service reductions at health facilities that serve Native Americans.

Indian Country has a unique relationship to Medicaid, because the program helps tribes cover chronic funding shortfalls from the Indian Health Service, the federal agency responsible for providing health care to Native Americans.

Medicaid has accounted for about two-thirds of third-party revenue for tribal health providers, creating financial stability and helping facilities pay operational costs. More than a million Native Americans enrolled in Medicaid or the closely related Children’s Health Insurance Program also rely on the insurance to pay for care outside of tribal health facilities without going into significant medical debt. Tribal leaders are calling on Congress to exempt tribes from cuts and are preparing to fight to preserve their access.

“Medicaid is one of the ways in which the federal government meets its trust and treaty obligations to provide health care to us,” said Liz Malerba, director of policy and legislative affairs for the United South and Eastern Tribes Sovereignty Protection Fund, a nonprofit policy advocacy organization for 33 tribes spanning from Texas to Maine. Malerba is a citizen of the Mohegan Tribe.

“So we view any disruption or cut to Medicaid as an abrogation of that responsibility,” she said.

Tribes face an arduous task in providing care to a population that experiences severe health disparities, a high incidence of chronic illness, and, at least in western states, a life expectancy of 64 years — the lowest of any demographic group in the U.S. Yet, in recent years, some tribes have expanded access to care for their communities by adding health services and providers, enabled in part by Medicaid reimbursements.

During the last two fiscal years, five urban Indian organizations in Montana saw funding growth of nearly $3 million, said Lisa James, director of development for the Montana Consortium for Urban Indian Health, during a webinar in February organized by the Georgetown University Center for Children and Families and the National Council of Urban Indian Health.

The increased revenue was “instrumental,” James said, allowing clinics in the state to add services that previously had not been available unless referred out for, including behavioral health services. Clinics were also able to expand operating hours and staffing.

Montana’s five urban Indian clinics, in Missoula, Helena, Butte, Great Falls, and Billings, serve 30,000 people, including some who are not Native American or enrolled in a tribe. The clinics provide a wide range of services, including primary care, dental care, disease prevention, health education, and substance use prevention.

James said Medicaid cuts would require Montana’s urban Indian health organizations to cut services and limit their ability to address health disparities.

American Indian and Alaska Native people under age 65 are more likely to be uninsured than white people under 65, but 30% rely on Medicaid compared with 15% of their white counterparts, according to KFF data for 2017 to 2021. More than 40% of American Indian and Alaska Native children are enrolled in Medicaid or CHIP, which provides health insurance to kids whose families are not eligible for Medicaid. KFF is a health information nonprofit that includes KFF Health News.

A Georgetown Center for Children and Families report from January found the share of residents enrolled in Medicaid was higher in counties with a significant Native American presence. The proportion on Medicaid in small-town or rural counties that are mostly within tribal statistical areas, tribal subdivisions, reservations, and other Native-designated lands was 28.7%, compared with 22.7% in other small-town or rural counties. About 50% of children in those Native areas were enrolled in Medicaid.

The federal government has already exempted tribes from some of Trump’s executive orders. In late February, Department of Health and Human Services acting general counsel Sean Keveney clarified that tribal health programs would not be affected by an executive order that diversity, equity, and inclusion government programs be terminated, but that the Indian Health Service is expected to discontinue diversity and inclusion hiring efforts established under an Obama-era rule.

HHS Secretary Robert F. Kennedy Jr. also rescinded the layoffs of more than 900 IHS employees in February just hours after they’d received termination notices. During Kennedy’s Senate confirmation hearings, he said he would appoint a Native American as an assistant HHS secretary. The National Indian Health Board, a Washington, D.C.-based nonprofit that advocates for tribes, in December endorsed elevating the director of the Indian Health Service to assistant secretary of HHS.

Jessica Schubel, a senior health care official in Joe Biden’s White House, said exemptions won’t be enough.

“Just because Native Americans are exempt doesn’t mean that they won’t feel the impact of cuts that are made throughout the rest of the program,” she said.

State leaders are also calling for federal Medicaid spending to be spared because cuts to the program would shift costs onto their budgets. Without sustained federal funding, which can cover more than 70% of costs, state lawmakers face decisions such as whether to change eligibility requirements to slim Medicaid rolls, which could cause some Native Americans to lose their health coverage.

Tribal leaders noted that state governments do not have the same responsibility to them as the federal government, yet they face large variations in how they interact with Medicaid depending on their state programs.

President Donald Trump has made seemingly conflicting statements about Medicaid cuts, saying in an interview on Fox News in February that Medicaid and Medicare wouldn’t be touched. In a social media post the same week, Trump expressed strong support for a House budget resolution that would likely require Medicaid cuts.

The budget proposal, which the House approved in late February, requires lawmakers to cut spending to offset tax breaks. The House Committee on Energy and Commerce, which oversees spending on Medicaid and Medicare, is instructed to slash $880 billion over the next decade. The possibility of cuts to the program that, together with CHIP, provides insurance to 79 million people has drawn opposition from national and state organizations.

The federal government reimburses IHS and tribal health facilities 100% of billed costs for American Indian and Alaska Native patients, shielding state budgets from the costs.

Because Medicaid is already a stopgap fix for Native American health programs, tribal leaders said it won’t be a matter of replacing the money but operating with less.

“When you’re talking about somewhere between 30% to 60% of a facility’s budget is made up by Medicaid dollars, that’s a very difficult hole to try and backfill,” said Winn Davis, congressional relations director for the National Indian Health Board.

Congress isn’t required to consult tribes during the budget process, Davis added. Only after changes are made by the Centers for Medicare & Medicaid Services and state agencies are tribes able to engage with them on implementation.

The amount the federal government spends funding the Native American health system is a much smaller portion of its budget than Medicaid. The IHS projected billing Medicaid about $1.3 billion this fiscal year, which represents less than half of 1% of overall federal spending on Medicaid.

“We are saving more lives,” Malerba said of the additional services Medicaid covers in tribal health care. “It brings us closer to a level of 21st century care that we should all have access to but don’t always.”

This article was published with the support of the Journalism & Women Symposium (JAWS) Health Journalism Fellowship, assisted by grants from The Commonwealth Fund.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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“Breaking news: The Trump administration just announced that Medicare will stop covering telehealth starting April 1. … We need to stand up to these Medicare cuts.”

Rep. Ro. Khanna (D-Calif.), in a TikTok video posted Feb. 20, 2025

Rep. Ro Khanna (D-Calif.) posted a Tiktok video on Feb. 20 saying he had “breaking news” about the fate of Medicare coverage for telehealth visits, which allow patients to see health care providers remotely from their homes.

“Breaking news: The Trump administration just announced that Medicare will stop covering telehealth starting April 1,” Khanna said. “We need to stand up to these Medicare cuts.”

The same day, the Centers for Medicare & Medicaid Services posted a document online titled “Telehealth” that said, “Through March 31, 2025, you can get telehealth services at any location in the U.S., including your home. Starting April 1, 2025, you must be in an office or medical facility located in a rural area (in the U.S.) for most telehealth services.”

CMS did not respond to requests for comment about the post. The White House also did not respond to requests for comment.

The telehealth benefit was first put in place as a temporary Trump-era addition to Medicare coverage during the covid-19 public health emergency.

Khanna’s statement took on more significance leading up to the threat of a government shutdown, but late last week Congress averted one by approving a stopgap spending bill.

The expiration date for the benefit has been known since December, when Congress extended coverage around telehealth through March 31. The roughly 90-day reprieve was part of a compromise after then-President-elect Donald Trump and his ally Elon Musk criticized a sweeping, end-of-year legislative package that would have, among other things, continued those benefits for two years.

Their opposition forced Congress to pass a stripped-down version of the end-of-year bill. Telehealth’s two-year extension, included in the initial bill, became collateral damage.

Last week, just as the clock was ticking down, House Republicans passed a spending bill for the rest of the fiscal year that includes another extension of telehealth flexibilities — this one lasting through September. The Senate then cleared the bill for Trump’s signature, with the support of 10 Democrats, including Senate Minority Leader Chuck Schumer.

Regardless, the two-year extension proposed in December — or a permanent extension, as Khanna has urged — looks unlikely.

“President Trump and Elon Musk blew up the continuing resolution last December that would have extended these telehealth authorities by two years,” Khanna told us via email. “Trump should work with Congress to extend telehealth coverage for Medicare beneficiaries.”

It wouldn’t come free. Permanently extending telehealth for medical care under Medicare could cost taxpayers about $25 billion over 10 years, the Congressional Budget Office has estimated. The CBO calculated five months of expanded telehealth coverage as costing $663 million, and calculated that that would total almost $25 billion through fiscal year 2031 if spending remained level, which it may not do.

Also, the agency and the Government Accountability Office have raised concerns about fraud and overuse of the benefit, among other potential issues.

Congress made Medicare coverage of behavioral health services delivered remotely permanent in December 2020, but left other telehealth benefits hanging on by a string. Instead, lawmakers extended them for short periods during the nearly two years since the public health emergency officially ended in May 2023.

“Now, once again, we’ve got another deadline where, if Congress doesn’t act, our flexibilities go away,” said Kyle Zebley, senior vice president of public policy for the American Telemedicine Association.

And if, at some point, the telehealth benefits aren’t extended, is it fair to describe the policy change as a cut? Khanna, for instance, plans to introduce the Telehealth Coverage Act, which would require Medicare to cover seniors’ telehealth services.

Politically speaking, it’s a powerful question when trying to leverage public support — and politicians in both parties often accuse their opponents of “cutting” federal benefits when they make changes to programs.

“Khanna is overly dramatic,” said Joseph Antos, a senior fellow emeritus at the American Enterprise Institute, a conservative think tank.

If the provision expires, Antos said, “this is not a Trump cut.”

But beneficiaries might have a different experience. Since the early days of the pandemic — five years now — millions of patients have come to rely on telehealth for their medical services. That benefit, even with another temporary reprieve, would still be at risk.

According to CMS, more than 1 in 10 Medicare beneficiaries used virtual care services as of 2023. And, after the Trump administration green-lighted telehealth for Medicare recipients in 2020, many private insurers did the same.

Overall telehealth claims in Medicare rose from fewer than 1% of all claims before the covid pandemic to a peak of 13% in April 2020. Now they stand at close to 5%, according to Fair Health, a nonprofit that tracks health care costs.

Those in the telehealth industry are optimistic about the current extension. The Trump administration, they say, has been sending encouraging signals — even highlighting its previous support of telemedicine in its fact sheet on the launch of the President’s Make America Healthy Again Commission.

“We’ve been sweating bullets,” Zebley said. “But it’s been nerve-wracking before. I think we’re going to get it done.”

Antos said, however, that after the extension in the House-passed spending bill, Medicare’s telemedicine benefits could be dead.

Our Ruling

Khanna said, “Breaking news: The Trump administration just announced that Medicare will stop covering telehealth starting April 1. … We need to stand up to these Medicare cuts.”

The statement is partially accurate, because the Trump administration announced the March 31 sunset of Medicare telehealth visits, and some beneficiaries who were using that benefit could see it as a “cut.” But the claim lacks key context that the expiration date was set by Congress, not the Trump administration.

After Khanna’s claim, Congress extended access to telehealth coverage through September.

Based on information that was available at the time, we rate Khanna’s statement Half True.

Our Sources:

Rep. Ro Khanna’s Feb. 20, 2025 TikTok video.

The American Relief Act, 2025.

Vice President J.D. Vance’s X post on behalf of himself and President Donald Trump on the year-end legislative package, Dec. 18, 2024.

One of a flurry of Elon Musk’s X posts deriding the government’s year-end legislative package, Dec. 20, 2024.

Email interview with Rep. Ro Khanna’s office, March 3, 2025.

H.R.1968 — Full-Year Continuing Appropriations and Extensions Act, 2025.

H.R.133 — Consolidated Appropriations Act, 2021

Phone interview and follow-up texts with Kyle Zebley, senior vice president of public policy for the American Telemedicine Association and executive director of ATA Action, March 3, 2025.

Email interview with Joseph Antos, senior fellow emeritus for public policy research at the think tank the American Enterprise Institute, March 8, 2025.

A Centers for Medicare & Medicaid Services post CMS post titled “Telehealth” that includes information to recipients about Medicare telehealth benefits ending April 1, 2025.

The journal Primary Care, “The State of Telehealth Before and After the COVID-19 Pandemic,” April 25, 2022.

CMS, “Medicare Telehealth Trends,” Jan. 1, 2020 and June 30, 2024.

“Fiscal Considerations for the Future of Telehealth,” Committee for a Responsible Federal Budget, April 21, 2022.

H.R. 2471, the Consolidated Appropriations Act, 2022, Congressional Budget Office, March 14, 2022.

“Medicare and Medicaid: COVID-19 Program Flexibilities and Considerations for Their Continuation,” U.S. Government Accountability Office, May 19, 2021.

Preprint: “Telehealth and Outpatient Utilization: Trends in Evaluation and Management Visits Among Medicare Fee-For-Service Beneficiaries, 2019-2024,” March 6, 2025.

Preprint: “Association Between Telehealth Use and Downstream 30-Day Medicare Spending,” Feb. 11, 2025.

Ro Khanna’s press release on the telehealth bill he’s introducing.

“Annual Number of Users of Online Doctor Consultations Worldwide From 2017 to 2028,” Statista Market Insights, March 15, 2024.

ATA Action letter to Congress, Jan. 13, 2025.

Make America Healthy Again fact sheet, Feb. 13, 2025.

CMS, “Medicare Telehealth Trends Report,” October 2024.

Spending cuts, immigration, and Medicaid are at the top of the Washington agenda. That climate provides fertile ground for misinformation and myths to multiply on social networks. Some of the most common are those surrounding immigrants, Latinos, and Medicaid.

These claims include assertions that Latinos who use Medicaid, the federal-state program for low-income people and those with disabilities, “do not work” and exaggerations of the percentage of people with Medicaid who are Latinos.

The U.S. House voted narrowly on Feb. 25 in favor of a budget blueprint that could lead to Medicaid cuts of up to $880 billion over a decade.

Medicaid and the Children’s Health Insurance Program are part of the national safety net, covering about 80 million people. Medicaid enrollment grew under the Affordable Care Act and after the start of the covid-19 pandemic but then started falling during the final two years of the Biden administration.

Immigrants’ impact on the nation’s health care system can be overstated in heated political rhetoric. Now-Vice President JD Vance said on the campaign trail last year that “we’re bankrupting a lot of hospitals by forcing these hospitals to provide care for people who don’t have the legal right to be in our country.” PolitiFact rated that statement “False.”

KFF Health News, in partnership with Factchequeado, compiled five myths circulating on social media and analyzed them with experts in the field.

1. Do Latinos who receive Medicaid work?

Most do. A KFF analysis of Medicaid data found that almost 67% of Latinos on Medicaid work, “which is a higher share of Medicaid adults who are working compared to other racial and ethnic groups,” said Jennifer Tolbert, deputy director of KFF’s Program on Medicaid and the Uninsured. KFF is a health information nonprofit that includes KFF Health News.

“For many low-income people, the myth is that they are not working, even though we know from a lot of data that many people work but don’t have access to affordable employer-sponsored insurance,” said Timothy McBride, co-director at the Center for Advancing Health Services, Policy and Economics Research, part of the Institute for Public Health at Washington University in St. Louis.

Neither the Department of Health and Human Services Office of Minority Health nor the Centers for Medicare & Medicaid Services responded to requests for comment.

2. Are Latinos the largest group enrolled in Medicaid?

No. White people who are not Hispanic represent the biggest demographic group in Medicaid and CHIP. The programs’ enrollment is 42% non-Hispanic white, 28% Latinos, and 18% non-Hispanic Black, with small percentages of other minorities, according to a CMS document.

Latinos’ share of total Medicaid enrollment “has remained fairly stable for many years — hovering between 26 and 30% since at least 2008,” said Gideon Lukens, research and data analysis director on the health policy team at the left-leaning Center on Budget and Policy Priorities, a research organization.

In a Feb. 18 blog post, Alex Nowrasteh and Jerome Famularo of the libertarian Cato Institute wrote: “The biggest myth in the debate over immigrant welfare use is that noncitizens — which includes illegal immigrants and those lawfully present on various temporary visas and green cards — disproportionately consume welfare. That is not the case.” They included Medicaid in the term “welfare.”

Although Latinos are not the biggest group in Medicaid, they are the demographic group with the greatest percentage of people receiving Medicaid. There are about 65.2 million Hispanics in the country, representing 19.5% of the total U.S. population.

Approximately 31% of the Latino population is enrolled in Medicaid, in part because employed Latinos often have jobs that do not offer affordable insurance.

Eligibility for Medicaid is based on factors such as income, age, and pregnancy or disability status, and it varies from state to state, said Kelly Whitener, associate professor of practice at the Center for Children and Families at Georgetown University’s McCourt School of Public Policy.

“Medicaid eligibility is not based on race or ethnicity,” Whitener said.

3. Do most Latinos living in the country without legal permission use Medicaid?

No. Under federal law, immigrants lacking legal status are not eligible for federal Medicaid benefits.

As of January, 14 states and the District of Columbia had used their own funds to expand coverage to children in the country without regard to immigration status. Of those, seven states and D.C. expanded coverage to some adults regardless of immigration status.

The cost of providing health care to these beneficiaries is covered entirely by the states. The federal government does not put up a penny.

The federal government does pay for Emergency Medicaid, which reimburses hospitals for medical emergencies for people who, because of their immigration status or other factors, do not normally qualify for the program.

Emergency Medicaid began in 1986 under the Emergency Medical Treatment and Labor Act, signed by President Ronald Reagan, a Republican.

In 2023, Emergency Medicaid accounted for 0.4% of total Medicaid spending.

Some conservative lawmakers say immigrants in the country illegally should not get any Medicaid benefits.

“Medicaid is meant for American citizens who need it most — seniors, children, pregnant women, and the disabled,” Rep. Dan Crenshaw (R-Texas) said on social media. “But liberal states are finding ways to game the system and make taxpayers cover healthcare for illegal immigrants.”

4. Do Latinos stay on Medicaid for decades?

Experts say there is no analysis by race or ethnicity of the length of time people use the program.

“The people who stay on Medicaid the longest are people who have Medicaid due to a disability and who live with a medical situation that does not change,” Tolbert said.

People who use long-term Medicaid support services represent 6% of the total number of people in the program.

Many beneficiaries are in the program temporarily, McBride said.

“Some studies indicate that as many as half of the people on Medicaid churn off of Medicaid within a short period of time,” he said, such as within a year.

5. Are Latinos on Medicaid the group that uses medical services the most?

Latinos do not use significantly more Medicaid services than others, experts say. Latinos receive preventive services (such as mammograms, pap smears, and colonoscopies), primary care and mental health care less than other groups, according to documents from CMS and the Medicaid and CHIP Payment and Access Commission, a nonpartisan organization that provides policy and data analysis.

Latinos do account for a disproportionate share of Medicaid labor and delivery services. Latino families and white families each represent about 35% of Medicaid births, although white people make up a bigger share of the overall population.

While Latinos represent 28% of all Medicaid and CHIP enrollees, they account for 37% of beneficiaries with limited benefits that cover only specific services.

“They actually use health care services less than other groups, because of systemic barriers such as limited English proficiency and difficulty navigating the system,” said Arturo Vargas Bustamante, a professor at UCLA’s Fielding School of Public Health and the faculty research director at the university’s Latino Policy and Politics Institute.

Latino people also avoid using services out of fear of the “public charge” rule and other policies, Vargas Bustamante said. President Donald Trump expanded the public charge policy and strongly enforced it during his first term, though it was softened under President Joe Biden. The policy was intended to make it harder for immigrants who use Medicaid or welfare programs to obtain green cards or become U.S. citizens.

“The chilling effect of public charge persists, but recent orders such as mass deportation or the elimination of birthright citizenship have generated their own chilling effects,” Vargas Bustamante added.